Individual
CORY MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 S 2ND AVE, WALLA WALLA, WA 99362
(509) 897-3700
Mailing address
PO BOX 32, LIBERTY LAKE, WA 99019-0032
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD60878010
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106443
—
WA
Enumeration date
05/01/2014
Last updated
06/18/2021
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